Introduction.: The evaluation and improvement of the quality of health care services begins with the knowledge about the trends and causes of diseases. Purpose: To describe the morbidity and mortality patterns for the under-5 year old children who were admitted in 11 district hospitals in Eastern Cape Province from 2000 to 2004. Methods: Descriptive study where a multi-stage sampling technique was used to select 11 district hospitals. There were 25,122 causes of paediatric ward admissions (2000 to 2004) among under-5 children from ward register were reviewed and ICD-10 coded. Findings: Pre-transitional causes were the leading causes of morbidity (68.4%) and mortality (74.2%) especially diarrhoeal lower respiratory tract infections and protein-energy malnutrition. There was particularly among male high infant morbidity and mortality rates observed from 2000 to 2004. Non-communicable diseases (8% morbidity and 4.2% mortality) and injuries (10% morbidity and 4.4% mortality) appeared to be of less public health concern among the under-5 children. Majority of under-5 mortality (43.4%) occurred within 24 hours of admissions (23.7% died on arrival). Influential variables for morbidity and mortality were region (Eastern), age (infants), year admitted and broad classification of the diseases (group I causes). There was a constant increase in morbidity and mortality which was observed during studied period. Conclusion: Pre-transitional causes (especially diarrhoeal, lower respiratory tract infections and protein energy malnutrition) were of public health concern among the under-5 children and their magnitude has increased over the years studied. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Clinical Epidemiology / unrestricted